Provider Demographics
NPI:1477160489
Name:FIKE, KEEGAN (MT-BC)
Entity Type:Individual
Prefix:
First Name:KEEGAN
Middle Name:
Last Name:FIKE
Suffix:
Gender:M
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 WRIGHT ST APT 6-305
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-1418
Mailing Address - Country:US
Mailing Address - Phone:352-857-9863
Mailing Address - Fax:
Practice Address - Street 1:2222 S FRASER ST UNIT 2
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-4515
Practice Address - Country:US
Practice Address - Phone:303-481-8134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-24
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
16059225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist